P1672: ARTERIAL EMBOLISM IN A NATIONWIDE COHORT OF PATIENTS WITH INFLAMMATORY BOWEL DISEASES
Authors: A. Abomhya, Z. Abdulsada, H. Hamad
Journal: HemaSphere (2022)

Background: Inflammatory bowel disease (IBD) patients are at a significantly high risk of thromboembolism events. Arterial embolism is a rare but dire condition with only a few reported cases among IBD patients. Systemic chronic inflammation, thrombocytosis, abnormal platelet functions, proinflammatory cytokines, hypertension, obesity, diabetes, and dyslipidemia contribute to the elevated risk of thromboembolic events. Aims: This retrospective cohort study aimed to estimate the prevalence of arterial embolism among hospitalized IBD patients. Secondary outcomes included mortality, length of stay, all-cause 30-day non-elective readmission rate, and total cost of hospitalization. Methods: We queried the Nationwide Readmission Databases 2016-2018 using ICD-10-CM codes to identify all adult patients admitted for IBD. Patients with a comorbid diagnosis of arterial embolism (ICD-10-CM: I74.x) were identified. Median and IQR were used to describe Continuous variables, and proportions were used with categorical variables. Comparison between groups was performed by Mann Whitney test for continuous variables and Chi-Square test for Categorical variables. Multivariate regression analysis was performed to study the impact of comorbid arterial embolism on inpatient mortality and non-elective readmissions. Statistical analyses were performed using SPSS Version 25 (IBM Corporation, Armonk, NY, USA). Results: We extracted 365,152 index hospitalization records for IBD. Of whom, 774 (0.2%) had a comorbid arterial embolism. IBD patients with arterial embolism were older (63; Interquartile Range (IQR): 53-74 vs. 56; IQR: 38-70, P <0.001), more common to be females (53% vs. 47%, P= 0.028), more common to have hypertension (38.4% vs. 31.6%, P <0.001), dyslipidemia (35.8% vs. 24.7%, P <0.001), diabetes (20.8% vs. 17.2%, p= 0.008), ESRD (4% vs. 1.6%, p <0.001) and hepatic failure (4.9% vs. 1%, p <0.001) compared to IBD patients without arterial embolism respectively. Essential thrombocythemia (3.9% vs 1.2%, P <0.001) and hepatic failure (4.9% vs. 1%, p <0.001) were more common among IBD patients with arterial embolism compared to those without arterial embolism respectively. Having arterial embolism was associated with increased length of stays in days (7; Interquartile Range (IQR): 4-17 vs. 3; IQR: 2-6, P <0.001), increased median total charges ($112,712; IQR: $48,807 - $245,548 vs. $32,581; IQR: $17,826 - $62,251, P <0.001). On multivariate analysis and after adjusting for comorbid conditions, having arterial embolism was associated with increased mortality (Odds ratio (OR): 5.575; 95% confidence interval (CI): 4.369-7.114, P <0.001) and higher odds of all-cause 30-day non-elective readmission (OR: 1.294; 95% CI: 1.028-1.627, P= 0.028). Summary/Conclusion: In a large nationwide cohort of patients hospitalized for IBD, we identified 774 cases of an arterial embolism which was associated with significantly worse hospitalization outcomes. We highlighted rare but significant comorbidity that can have multiple clinical presentations. Clinicians should be aware of the increased risk of thromboembolic events in IBD patients which include venous thromboembolism and arterial embolism.